Voice disorders place over five million school-aged children at increased risk for inferior school performance, dysfunctional social development, and higher participation in criminal activities. The lesions most commonly associated with pediatric vocal dysfunction are reported to be vocal fold nodules, which are present in up to 21% of the general population, and are associated with behavioral problems and inferior quality of life. Voice therapy with a speech-language pathologist is recommended by 95% of otolaryngologists for management of vocal fold nodules. This most widely used treatment for the most common lesion associated with pediatric voice disorders has not been rigorously tested in prospective controlled trials to determine whether it truly has benefits that outweigh the associated risks. A prospective clinical trial addressing whether voice therapy improve voice-related quality of life for children with apparent vocal fold nodules is a logical step toward developing an evidence-based treatment plan to optimize outcomes for this sizable population of at-risk children. There are currently no well-powered, prospective, controlled studies which compare voice therapy versus control in children who present with apparent nodules. Our goal is to remedy this deficiency through the randomized, placebo controlled study outlined in the following grant proposal. PUBLIC HEALTH RELEVANCE: Voice disorders place over five million school-aged children at increased risk for inferior school performance, dysfunctional social development, and higher participation in criminal activities. The most widely used treatment for the most common lesion associated with pediatric voice disorders has not been rigorously tested in prospective controlled trials to determine whether it truly has benefits that outweigh the associated risks. A prospective clinical trial addressing whether voice therapy improves voice-related quality of life for children with apparent vocal fold nodules is a logical step toward developing an evidence-based treatment plan to optimize outcomes for this sizable population of at-risk children.